A single dose of the inactivated whole-cell OCV offered protection to older children and adults that was sustained for at least 2 years. The absence of protection of young children might reflect a lesser degree of pre-existing natural immunity in this age group.

2. [Comment] Cholera control: one dose at a time

The Lancet Infectious Diseases, 15.03.2018Tilføjet 15.03.2018 00:40

Louise C Ivers

Cholera continues to harm the most vulnerable people worldwide.1 As an indicator of human progress, the sustained or new presence of the disease in any region is a stark reminder of how far we, as a society, have to go to reach Sustainable Development Goal 6: ensuring availability and sustainable management of water and sanitation for all.2 Diarrhoeal diseases are a major source of preventable morbidity and mortality, and in 2015 claimed the lives of more than 1·3 million people, of whom 499 000 were children younger than 5 years.

Treatment for drug-resistant tuberculosis is largely delivered through standardised, empirical combination regimens in low-resource, high-burden settings. However, individualised treatment, guided by detailed drug susceptibility testing, probably results in improved individual outcomes and is the standard of care in well-resourced settings. Driven by the urgent need to scale up treatment provision, new tuberculosis drugs, incorporated into standardised regimens, are being tested. Although standardised regimens are expected to improve access to treatment in high-burden settings, they are also likely to contribute to the emergence of resistance, even with good clinical management.

Oral fluid tests for HIV are less sensitive than blood tests and more likely to miss recent infections, thanks to lower levels of viral antibodies in saliva compared with blood. Yet saliva tests, which are more practical and cheaper than blood tests, are commonly used to screen for HIV in public health settings where the use of needles may be unsafe or logistically difficult. These settings include jails, community-based organizations without certified phlebotomists on staff, and high schools and community colleges.

Objectives
The objectives of this work were to evaluate (i) the prevalence and frequency of caregiver‐reported soil ingestion by children, (ii) whether household flooring material in the bedroom (earth versus concrete) affected caregiver‐reported soil ingestion, (iii) whether caregiver‐reported soil ingestion was associated with caregiver‐reported diarrhoea, and (iv) caregivers’ perceptions of their children ingesting soil.
Methods
We conducted 309 household surveys in northern Ghana, including 529 children under five (249 children aged 6‐36 months), and measured faecal contamination in soil from 31 households.
Results
Among all children, 15% were reported to have directly ingested soil in the past week, including 28% of children aged 6‐36 months. Among children reported to have ingested soil, the median frequency was 14 times in the past week, and the median amount of soil ingested each time was half a handful. There was no association between household floor material and whether the caregiver observed a child directly ingesting soil. After adjusting for household floor material and other potential confounding variables, caregiver‐reported soil ingestion was associated with caregiver‐reported diarrhoea for children under five [adjusted odds ratio (adj. OR)=3.13, 95% confidence interval (CI) 2.76‐3.55] and children aged 6‐36 months (adj. OR=2.61, 95% CI 2.01‐3.39). Approximately 83% of caregivers whose children ingested soil reported they thought it was unsafe and were more likely to report stopping their child from ingesting soil, but these responses did not affect the quantity of soil ingested.
Conclusions
Our results suggest direct soil ingestion is associated with diarrhoea independent of household floor material and separate interventions may be necessary to prevent exploratory soil ingestion.
This article is protected by copyright. All rights reserved.

8. Development of a rapid and visual nucleotide detection method towards an Chinese epidemic strain of Orientia tsutsugamushi based on recombinase polymerase amplification assay and lateral flow test

In January, the U.S. Department of Health and Human Services (HHS) announced the creation of its Conscience and Religious Freedom Division, explaining that it will allow HHS’s Office of Civil Rights to "more vigorously and effectively enforce existing laws protecting the rights of conscience and…

Rapidly and accurately identifying individuals who are at high risk for Middle East respiratory syndrome coronavirus (MERS‐CoV) remains a major challenge for the medical and scientific communities. The aim of this study was to develop and validate a risk prediction model for the screening of suspected cases of MERS-CoV infection in patients who had developed pneumonia.

13. High Medication Possession Ratios Associated with Greater Risk of Virologic Failure Among Youth Compared to Adults in a Nigerian Cohort

AbstractBackground:Medication possession ratio (MPR) is widely used as a measure of adherence to antiretroviral therapy (ART). Many adolescents and young adults (AYA) experience ART adherence challenges. Our objective was to determine whether the relationship between MPR and virologic failure (VF) is consistent between AYA and older adults in Nigeria.Methods:We conducted a retrospective study of AYA (15-25 years) and adults (>25 years) who initiated ART between January 2009 and December 2012 at 10 university-affiliated HIV clinics in Nigeria. We used multivariate generalized linear models to assess the relationship between age, MPR (ART doses dispensed)/(days since ART initiation), and risk of VF (HIV RNA >1,000 copies/mL) in the first year on ART.Results:The cohort included 1,508 AYA and 11,376 older adults. VF was more common in AYA than older adults (30% vs. 24% p94%, 80-94%, and 94% aRR 0.43, p1,000 copies/mL) in the first year on ART.
Results:
The cohort included 1,508 AYA and 11,376 older adults. VF was more common in AYA than older adults (30% vs. 24% p94%, 80-94%, and 94% aRR 0.43, p

14. HIV Care in Central and Eastern Europe:How close are we to the target?

Objectives
Safe drinking water, sanitation and hygiene are protective against diarrhoeal disease; a leading cause of child mortality. The main objective was an updated assessment of the impact of unsafe water, sanitation and hygiene (WaSH) on childhood diarrhoeal disease.
Methods
We undertook a systematic review of articles published between 1970 and February 2016. Study results were combined and analysed using meta‐analysis and meta‐regression.
Results
A total of 135 studies met the inclusion criteria. Several water, sanitation and hygiene interventions were associated with lower risk of diarrhoeal morbidity. Point‐of‐use filter interventions with safe storage reduced diarrhoea risk by 61% (RR=0.39; 95% CI: 0.32, 0.48); piped water to premises of higher quality and continuous availability by 75% and 36% (RR=0.25 (0.09, 0.67) and 0.64 (0.42, 0.98)), respectively compared to a baseline of unimproved drinking water; sanitation interventions by 25% (RR=0.75 (0.63, 0.88)) with evidence for greater reductions when high sanitation coverage is reached; and interventions promoting handwashing with soap by 30% (RR=0.70 (0.64, 0.77)) versus no intervention. Results of the analysis of sanitation and hygiene interventions are sensitive to certain differences in study methods and conditions. Correcting for non‐blinding would reduce the associations with diarrhoea to some extent.
Conclusions
Though evidence is limited, results suggest that household connections of water supply and higher levels of community coverage for sanitation appear particularly impactful which is in line with targets of the Sustainable Development Goals.
This article is protected by copyright. All rights reserved.

AbstractInfection with M. tuberculosis is associated with inconsistent and incomplete elimination of the bacteria, despite development of antigen-specific T cell responses. One mechanism employed by M. tuberculosis is to limit availability of antigen for activation of CD4 T cells. We examined the utility of systemic administration of epitope peptides to activate pre-existing T cells in mice infected with M. tuberculosis. We found that systemic peptide administration: 1) selectively activates T cells specific for the epitope peptide; 2) loads MHC class II on lung macrophages and dendritic cells; 3) activates CD4 T cells in the lung parenchyma; 4) has little antimycobacterial activity. Further studies revealed that CD4 T cells in lung lesions are distant from the infected cells, suggesting that, even if they can be activated, the positioning of CD4 T cells and their direct interactions with infected cells may be limiting determinants of immunity in TB.

18. Nationwide Trend of Sepsis: A Comparison Among Octogenarians, Elderly, and Young Adults

AbstractThere is growing evidence that hepatitis E virus (HEV) infection can present with extrahepatic manifestations including neurological disorders. Among these, neuralgic amyotrophy (NA) has been reported to occur in some industrialized countries. We investigated 35 patients with NA and a control group for markers of HEV infection. Acute HEV infection was found in NA patients only and was associated with an inflammatory response in the central nervous system. Shedding of HEV RNA into the cerebrospinal fluid and intrathecal production of anti-HEV IgM occurred in one patient suggesting that HEV is neurotropic.

To the Editor—We read with great interest the article by Sicre de Fontbrune et al on immunogenicity and safety of yellow fever (YF) vaccine in allogeneic hematopoietic stem cell transplant (HSCT) recipients [1]. The authors studied a cohort of pediatric patients, mostly diagnosed with sickle cell disease, who underwent YF vaccination after HSCT.

21. Phenotyping Cardiac Arrest: Bench and Bedside Characterization of Brain and Heart Injury Based on Etiology

22. Plasmodium Gametocytes in Field Studies: Do We Measure Commitment to Transmission or Detectability?

Trends in Parasitology, 12.03.2018Tilføjet 13.03.2018 09:25

Cristian Koepfli, Guiyun Yan

The proportion of Plasmodium spp. infections carrying gametocytes, and gametocyte densities, are often reported as surrogate markers for transmission potential. It remains unclear whether parasites under natural conditions adjust commitment to transmission depending on external factors. Population-based surveys comprising mostly asymptomatic low-density infections are always impacted by the sensitivity of the assays used to diagnose infections and detect gametocytes. Asexual parasite density is an important predictor for the probability of detecting gametocytes, and in many cases it can explain patterns in gametocyte carriage without the need for an adjustment of the gametocyte conversion rate.

AbstractBackgroundCavitation is a serious consequence of tuberculosis. We tested the hypothesis that repetitive exposure to the same total bacterial burden of Mtb drives greater lung destruction than a single exposure. We also tested whether inhibition of endogenous MMP1 may inhibit cavitation during TB.MethodsOver a three weeks interval we infected rabbits with either 5 aerosols of 500 CFU of Mtb or a single aerosol of 2500 CFU plus four sham aerosols. We administered the MMP1 inhibitor cipemastat (100 mg/kg daily) from week 5-10 to a subset of the animals.ResultsRepetitive aerosol infection produced greater lung inflammation and more cavities than a single aerosol infection of the same bacterial burden (75% of animals versus 25%). Necropsies confirmed greater lung pathology in repetitively exposed animals. For cipemastat-treated animals there was no significant difference in cavity counts, cavity volume, or disease severity compared to controls.ConclusionsOur data show that repetitive aerosol exposure with Mtb drives greater lung damage and cavitation than a single exposure. This suggests that human lung destruction due to TB may be exacerbated in settings where individuals are repeatedly exposed. MMP1-inhibition with cipemastat did not prevent the development of cavitation in our model.

To the Editor—Adler et al present a prospective cohort of 19 allogeneic stem cell recipients who were immunized with the yellow fever (YF) 17D vaccine before transplantation and identified the persistence of protective YF antibody titer in 79% of them. They compare their data to our previously published cohort [1]. Adler et al hypothesize that the highest frequency of persistent protective immunity in their cohort is explained by the lower age at transplant of our patients, underlying disease, and type of conditioning regimen. Although it is true for the cohort of patients vaccinated with YF vaccine after transplant, the cohort of patients studied for persistence of pretransplant immunity against YF vaccine mainly consisted of adults (13 of 15) transplanted for hematological malignancies (2 had aplastic anemia, 2 sickle cell disease, 8 acute leukemia, 1 myelodysplastic syndrome, and 2 non-Hodgkin lymphoma). Nevertheless, a large difference that could explain the discrepancy between our results and those of Adler et al is the median time between transplant and YF antibody titer evaluation: 12 months (1–72 months) in the Adler et al cohort and 4.3 years (0.62–11.5 years) in ours. This explanation is consistent with a rapid and progressive decline of the preexisting YF antibody titer in some patients after hematopoietic stem cell transplantation (HSCT), as observed in children having received measles vaccination before HSCT [2]. We agree that further large studies are needed to determine factors associated with the persistence of YF immunity after HSCT.

Prevention of tick-borne diseases in humans is challenging. To date, no prevention strategies have been shown to be consistently effective. Here, we describe the design of a new large-scale study, involving hundreds of households in Dutchess County, New York, testing whether environmental interventions, applied intensively and over 4 years, can prevent human cases.

AbstractBackgroundMaternally derived serum antibody and viral load are thought to influence disease severity in primary Respiratory Syncytial Virus (RSV) infection. As part of the AsPIRES study of RSV pathogenesis we correlated various serum antibody concentrations and viral load with disease severity.MethodsSerum neutralizing titers and IgG to RSV F, Ga and Gb proteins, the CX3C region of G, and nasal viral load were measured in 139 full-term previously healthy infants with primary RSV infection and correlated with illness severity.ResultsUnivariate analysis showed no relationship between measures of serum antibody and severity. However, a multivariate model adjusting for age at time of infection found a significant 0.56 decrease in severity score for each 2-fold increase in antibody concentration to RSV F protein. The benefit of antibody was greatest in infants ≤ 2 months of age. Additionally, estimated antibody titer at birth was correlated with age at infection, suggesting higher antibody titers delay infection. Viral load did not differ by illness severity.ConclusionOur data supports the concept of maternal immunization with an RSV vaccine during pregnancy as a strategy for reducing the burden of RSV infection in full-term healthy infants exposed to RSV during their first winter.

A 21% increase in US birth defects most strongly associated with gestational Zika virus infection (ZVI) was observed in regions of local transmission at the end of 2016, according to a recent CDC report. Infection with the virus during pregnancy has been strongly linked to microcephaly and other brain abnormalities, eye deformities, and other types of central nervous system dysfunction.